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Republicans grapple with voter frustration over rising health care premiums

  //health-fitness.news-articles.net/content/2025/ .. rustration-over-rising-health-care-premiums.html
  Published in Health and Fitness on Monday, October 27th 2025 at 8:57 GMT by Associated Press
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Summary of the AP News article “Health‑care subsidies under Obamacare could be hit by a shutdown”

The Associated Press article, published on October 21, 2023, examines how a potential federal shutdown could disrupt the payment of health‑care subsidies that are part of the Affordable Care Act (ACA). These subsidies, which have helped millions of Americans afford insurance premiums on the state and federal exchanges, are funded through annual appropriations in the federal budget. The piece explains the mechanics of the subsidy system, the risks posed by a shutdown, and the political context that could determine whether the subsidies remain on track.

How ACA subsidies work

Under the ACA, individuals and families whose incomes fall between 100 % and 400 % of the federal poverty level (FPL) may qualify for premium‑tax credits that lower the cost of insurance purchased on an exchange. The tax credits are calculated each month based on the household’s estimated income for the year and the “benchmark” plan offered by the exchange. If the actual premium is higher than the credit, the consumer pays the difference; if it is lower, the excess is returned to the insurer.

The subsidies are paid directly by the Treasury to the insurance carriers, who then distribute the funds to the enrollees. These payments are made using appropriated money; each year the Treasury requires a specific line item in the federal budget that earmarks funds for ACA subsidies. The article notes that, for the 2023 tax year, the subsidy program cost the federal government roughly $300 billion.

The threat of a shutdown

A federal shutdown occurs when Congress fails to pass a continuing resolution (CR) or a full budget act that authorizes the Treasury to spend money. If such a shutdown happens, the appropriated money for ACA subsidies would be frozen. The AP piece emphasizes that this would not mean an immediate loss of coverage for people currently enrolled, but it would delay the Treasury’s payments to insurance carriers. Until the payments resume, insurers might be forced to raise premiums or adjust coverage levels, potentially pushing some households into a coverage gap.

The article explains that the Treasury has a “pay‑by‑deadline” system: each carrier receives a quarterly estimate of the subsidies it is expected to deliver and must report the amounts received. A shutdown would halt that reporting, causing a backlog of payments that could take months to resolve once the budget is re‑approved. In the worst case, enrollees could see their tax credits stop mid‑year, forcing them to pay higher premiums or risk losing coverage entirely.

Political context and recent developments

The AP piece provides a brief overview of the political battles that have shaped the subsidy program over the past decade. It cites statements from the Centers for Medicare & Medicaid Services (CMS) that the ACA’s subsidies are “critical to keeping millions of Americans insured.” The article also references the 2019 budget negotiations, in which Congress approved a “$300 billion increase” to ACA subsidies to counteract rising premiums and to keep enrollment high.

The article notes that the current budget session includes a contentious debate over whether to keep subsidies at the current level or to phase them out as part of a broader “health‑care overhaul” proposed by some Republican lawmakers. The piece quotes a House Republican member who argues that subsidies “undermine the market” and that “a market‑based solution” would be more sustainable. Opponents of that view, including the Department of Health and Human Services (HHS) and several insurance industry groups, argue that subsidies are essential for maintaining affordability and that cutting them would lead to a loss of coverage for 9 million Americans, according to data released by the Kaiser Family Foundation.

Additional context from linked sources

The AP article includes a link to a CMS briefing document that outlines the annual budget cycle for ACA subsidies. Following that link, the briefing explains that the Treasury must receive a “subsidy‑approval order” each fiscal year, which is issued by the Office of Management and Budget (OMB) and signed by the President. The briefing also notes that the OMB publishes a quarterly “Subsidy Distribution Report” that shows how much has been paid out and how much remains outstanding. In the event of a shutdown, the OMB report would stop, creating a “data vacuum” that would make it difficult for insurers to forecast and plan.

The article also links to a recent analysis from the American Hospital Association (AHA), which warns that a shutdown could reduce the financial stability of health plans that rely heavily on ACA subsidies. The AHA analysis found that 30 % of small community health plans have a subsidy‑to‑premium ratio of over 50 %, meaning that a delay of even a single month could force them to adjust premium schedules or reduce benefits.

Bottom line

The AP News article presents a clear picture of the ACA subsidy program as a vital component of the U.S. health‑care safety net. It explains how subsidies are funded, how a federal shutdown could delay payments, and the potential ripple effects on insurers and enrollees. By situating the subsidy debate within the broader budget negotiations and referencing data from CMS, the AHA, and other policy groups, the piece underscores the urgency of passing a continuing resolution or full budget to keep millions of Americans insured.